HomeMy WebLinkAbout01-09-09J 15D56D41147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes county code Year File Number
PO BoX.2sotiol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT 2 1 0 8 0 0 3 8 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 O1 2008 04 11 1922
Decedent's Last Name Suffix Decedent's First Narne MI
FERRIS NORMAN L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
--
X 1. Original Return ~ ~ 2. Supplemental Return !r I 3, Remainder Retum (date of death
- ' prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise '- `
- (date of death after tz-12-s2) 'i_ I ~. Federal Estate Tax Return Required
X g Decedent Died Testate ~ Decedent Maintained a Living Trust O E•. Total Number of Safe De osit Boxes
(Attach Copy of Wily --, (Attach Copy of Trust) P
~~, 1 p. Spousal Poverty Credit (fdate of death II 11, Election to tax under Sec. 9113(A)
9. Litigation Proa~eds Received between 12-31-91 and 1.1-s5) L_
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRIAN C. LINSENBACH 7]L7 43?„~ 9733'`_;
Firm Name (If Applicable) l
SCHRACK & LINSENBACH PC
First line of address
124 W. HARRISBURG ST.
Second line of address
P. O. BOX 310
City or Post Office State ZIP Code
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DILLSBURG PA 17019-031.0
Correspondent'se-mail address: blinsenbach@COmCast.net
under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
~~~ ~ ~~ ~„ ~~ €lizabeth A. Ferris G/~C, '~~p q
A, CL -
802 Carol Circle, New Cumberland, PA 17070
SIGNATURE OF PREPARER. OTHER THAN REPRESENTATIVE DATE
Brian C. Linsennbach
HUUKtJJ
124 West Harrisburg Street, Dillsburg, PA 17019-0310
Side 1
L 15056041147
15D56041147 ~ C~
REV-1500 EX
oecedenPsName: Norman LaDue Ferris
RECAPITULATION
15056042148
1. Real Estate (Schedule A) ............................................................__........................ 1.
2. Stocks and Bonds (Schedule B) ..............................._............................._............. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) ............................._........................ 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ~ ] Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7,
8. Total Gross Assets (total Lines 1-7) .............................___...........................__..... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
11. Total Deductions (total Lines 9 & 10) ................................................................. 11.
12• Net Value of Estate (Line 8 minus Line 11) ..............................__........................... 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .....
_- _ - - --- ....................................... .. 14,
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousaY tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 3 0, 5 5 6. 2 1 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ............................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
108,000.00
5,108.60
985.01
25,206.15
139,299.76
36,060.57
72,682.98
108,743.55
30,556.21
30,556.21
0.00
1,375.03
0.00
0.00
1,375.03
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3 File Number 21-08-00383
Decedent's Complete Address:
DECEDENT'S NAME
Norman LaDue Ferris
--- - ---
STREET ADDRESS - - - - _ - - _ _
_- __
802 Carol Circle
CITY _ - - _ - _ _ _ _
STATE _ _ ZIP _ - -- - -
New Cumberland ! PA i 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
Make Check Payable fo: REGISTER OF WILLS, AGENT
(1) 1,375.03
(2> 0.00
(3)
(4) -- _ _
(5) 1,375.03
_- -
(5A)
(5B) 1,375.03
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :..................... _
... ~x
........................................ I
b. retain the right to designate who shall use the property transferred or its income :................................ ~_ l
c. retain a reversionary interest; or ............................................................................................................ - I-
d. receive the promise for life of either payments, benefits or care?...........
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ~ x
receiving adequate consideration? .............................. ~ --
...................................................................................
I xi
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... I X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .............................. ~ -~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)J. The statutedoes not exempts transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
__
0.00
Rev-1502 EX+ (8.98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferris, Norman LaDue 21-08-00383
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable Knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on schedule F.
t~~ ~n~~c space Is neeaea, aaalnonal pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleA (Rev. 6-98)
Rev-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF F'ENNSVLVANIA
INHERITANCE TAX: RETURN
RESIDENT DECEDENT
Ferris, Norman LaDue
ESTATE OF
FILE NUMBER
21-08-00383
All property jointly-owned with right of survivorship must be disclosed on Schedule F,
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 28.649 shares of International Business Machines 124.1568 3,556.97
Corporation
2 22 shares of Prudential Financial, Inc. 70.528584 1,551.63
TOTAL (Also enter on Line 2, Recapitulation) 5,108.60
tlr more space Is neetletl, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6.98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAk RETURN
RESIDENT DECEDENT
ESTATE OF
Ferris, Norman LaDue
FILE NUMBER
21-08-00383
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survlvorshlp must be disclosed on schedule F.
t.. ni~re space Is neeaeD, aanmonal pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+j6.98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ferris, Norman LaDue
ILE NUMBER
HA AD nnnnn
If an asset was made joint within one year of the decedent's date of death, It must be repoRed on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Elizabeth Ferris
B.
C.
802 Carol Circle Daughter
New Cumberland, PA 17070
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ,ASSET o
~0 OF
DECD'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A 7/13/2007 Americhoice Federal Credit Union - 25,206.15 100.000% 25
206
15
Checking Account #11657(13) ,
.
TOTAL (Also enter on Line 6, Recapitulation) I 25,206.15
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+(12.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ferris, Norman LaDue 21-08-00383
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
Hoffman-Roth Funeral Home & Crematory, Inc.
7,192.54
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Elizabeth A. Ferris
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 802 Carol Circle
City New Cumberland State PA z;p 17070
Year(s) Commission paid 2008
2. Attorney's Fees Schrack & Linsenbach PC
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Elizabeth A. Ferris
Street .Address 802 Carol Circle
city New Cumberland state PA zip 17070
Relationship of Claimant to Decedent daughter
6,600.00
7,500.00
3,500.00
4. Probate Fees 268.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 11,000.03
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 36,060.57
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ferris, Norman LaDue 21-08-00383
ITEM
NUMBER
DESCRIPTION
AMOUNT
1 Chestnut Real Estate Appraisal Services -appraisal of residence 325.00
2 Clerk of Orphans Court -Release filing fee 15.00
3 Closing costs to Seller regarding sale of 802 Carol Drive, New Cumberland, PA 8,925.00
property (see attached HUD-1)
4 Cumberland Law Journal -estate advertisement 75.00
5 Evening News (Metro West section) -estate advertisement 141.24
6 Miscellaneous expenses during administration 50.00
7 Register of Wills -Inheritance Tax Return filing fee 15.00
8 Reserve for future administrative expenses 1,000.00
9 Robin Gasperetti, Tax Collector 423.13
10 Transaction fee to Computershare for sale of IBM Stock 17,90
11 Transaction fee to Computershare for sale of Prudential Financial Stock 12.76
Subtotal I 11,000.03
Copyright (c) 2002 form software only The Lackner Group, Inc. f=orm PA-1500 Schedule H-67 (Rev. 6-98)
Rev1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF (FILE NUMBER
Ferris, Norman LaDue 21-08-00383
Include unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Department of Public Welfare -debt owed under Estate Recovery Program (see 40,221.85
attached)
2 Sarah A. Todd Home (debt of decedent)
3 Sarah A. Todd Memorial Home -payment on account balance (debt of decedent)
7,461.13
25,000.00
TOTAL (Also enter on Line 10, Recapitulation) I 72,682.98
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (g.00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ferris, Norman LaDue 21 _n8_nnsR~
NUMBER
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT
SHAF;E OF ESTATE
AMOUNT OF ESTATE
Do Not List Trustees (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
Elizabeth A. Ferris Daughter See Item 3 of 10,185.40
803 Carol Circle Last Will
New Cumberland, PA 17070
Paul N. Ferris Son See Item 3 of 10,185.40
114 Rose Sky Court Last W[II
Cary, NC 27513
Marcia J. Lamp Daughter See Item 3 of 10,185.40
11 B N. Baltimore Avenue Last Will
Mount Holly Springs, PA 17065
Total 30,556.20
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O 00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)
LAST WILL AND TESTAMENT.'
OF
NORMAN L. FERRIS
I, NORMAN L. FERRIS, of New Cumberland, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and expenses of my last
illness and funeral from my estate as soc>n after my death as
conveniently may be done. If there be no cemetery lot available
for my interment owned by me at the time of my death, I authorize
my personal representative to purchase such cemetery lot with a
contract for perpetual care, using therefore funds from my estate
in such amount as she shall consider necessary and desirable, and
I authorize my personal representative to cause title to or
ownership of such lot so purchased to be vested in such person as
my personal representative shall designate.
Further, I authorize my personal representative to expend
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle, PA
funds from my estate, in such amount as my personal representative
shall consider necessary and desirable for t]he purchase, erection
and inscription of a suitable marker for my grave.
SECOND
I give, .devise and bequeath all the rest, residue and
remainder of my estate to my beloved wife, HELENA J. FERRIS,
absolutely and in fee simple she survives me by thirty (30) days.
THIRD
In the event that my wife, HELENA J. FEF'.RIS, fails to survive
`~,
me by thirty (30) days, then I give, devise and bequeath all the
rest, residue and remainder of my estate in equal shares unto my
children, PAUL N. FERRIS, ELIZABETH A. FERRIS AND MARCIA J. LAMP,
per• stirpes .
FOURTH
I direct that any and all inheritance, estate, and transfer
taxes imposed upon my estate passing under this Will or otherwise
shall be paid out of the principal of my residuary estate.
FIFTH
In addition to the powers conferred by law, I authorize any
personal representative acting under this instrument, in her
absolute discretion:
A. To retain in the form received„ or to sell either at
public or private sale any real or personal property;
B. To exercise any options to subscribe for stocks,
bonds, or other investments;
C. To join in any plan of lease, mortgage,
consolidation, exchange, reorganization or foreclosure of any
corporation in which my estate or any trust may hold stocks,
bonds or other securities;
SAIDIS, GUIDO,
SHUFF &
MASLAND
26 W. High Street
Carlisle, PA
D. To sell, transfer, convey, mortgage, pledge, lease
or exchange any property, real or personal, which at any time
may form part of my estate, for the payment of debts or
taxes, or for any purpose of administra1tion or distribution,
2
for such prices and upon such teams as my personal
representative, in her sole discretion, may deem wise, and to
execute and deliver deeds of conveyance; or transfer thereof;
E. To make settlements and compromises on such terms as
my personal representative in her sole discretion may deem
wise without the necessity of obtaining any court approval
thereof;
F. To make distribution hereunder either in cash or
kind, as my personal representative i.n her discretion may
c ,,.
°~
SAIDIS, GUIDO,
SNUFF &
MASLAND
26 W. High Street
Cazlisle, PA
deem wise.
SIXTH
I do hereby nominate, constitute and appoint my wife, HELENA
J. FERRIS, to act as Executrix of this my La:~t Will and Testament.
Provided, however, that if she is unwilling or unable to act as
Executrix, I direct the duties of Alternate Executrix be performed
by ELIZABETH A. FERRIS.
SEVENTH
I direct that no personal representative, guardian, trustee
or other fiduciary appointed under this instrument shall be
required to give bond for the faithful performance of their duties
in any jurisdiction.
IN WITNESS WHEREOF, I, NORMAN L. FERRIS, have hereunto set my
hand and seal to this my Last Will and Testament, consisting of
four (4) typewritten pages, the first three (3) of which bear my
3
signature in the margin for identification, this ~~ day of
! V~~ /~rf~ 19 9 7 .
No an L. Fer°ris, Testator
Signed, sealed, published and declared by the above-named
NORMAN L. FERRIS, Testator, as and for his Last Will and Testament
in the presence of us, who have hereunto subscribed our names at
his request as witnesses thereto, in the presence of said Testator
and of each other.
l
f '
ADDRESS___~~~ y~ ~ ~ ISM
/~ ti ~ ~ ADDRESS / ~_
SAIDIS, GUIDO,
SNUFF &
MASLAND
26 W. High Street
Cazlisle, PA
4
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, NORMAN L. FERRIS, ~' ~ and Pa / S
(.~ ~, the Testator and witnesses, respectively whose names are
signed to the foregoing or attached instrument, being first duly
sworn, do hereby declare to the undersigned authority that the
Testator signed and executed the instrument as his Last Will and
Testament and that he signed willingly and that he executed as his
free and voluntary act for the purposes trterein expressed, and
that each of the witnesses, in the presence and hearing of the
Testator signed the Will as witnesses and that to the best of
their knowledge the Testator was at the time eighteen (18) or more
years of age, of sound mind and under no constraint or undue
influence .
Norman ~. Fermi s, Testator
--Witness
Witness
Subscribed, sworn to and acknowledged before me by NORMAN L.
5AIDIS, GUIDO,
SNUFF &
MASLAND
26 W. High Street
Cazlisle, PA
FERRIS, the Testator, andy~subscribed to and sworn or affirmed to
before me by ~ ~~, ~ . / / ~ and ~ ,~
witnesses, this ``~ day _±~~~%L+~a~-/ 1997.
~•
t Pu is
---:~:.
i a + pia;, -
Mem ._...:....
' ~ ,~ nb~o'Nbta'~~s ^ ~~
rvo. eouz-u[ao
,q, U.S. DEPARTMENT OF HOUSING AND URaAN DEVELOPMENT B. TYPE OF LOAN
SETTLEMENT STATEMENT 1. ~] FHA 2. FMHA 3. CONN. UNINS.
Affiliated Settlement Services Group, LLC a. ^ vA 5. ^ CONN. INS.
3912 Market Street B. ESCROW FILE NUMBER: 7. LOAN NUC,9BER:
00083564-001 RRH 6265111
Camp Hill, PA 17011
(717) 975-7839 B. MORTGAGE INSURANCE CASE NUMBER:
FINAL 441-867119-703
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(P.O.C.)" were paid outside the dosing; they are shown here for informational purposes and are not included in tha totals
D. NAME OF BORROWER: Timmy L. DOlln
ADDRESS OF BORROWER:
E. NAME OF SELLER: Estate Of Norman L. 1-errlS
ADDRESS OF SELLER:
F. NAME OF LENDER: WaCIIOVIa MOrtpape, FSB
ADDRESS OF LENDER: 1100 COrpOrate Center ~f.
Raleigh, NC 27607-5066
G. PROPERTY LOCATION: 802 Car01 CIFCIe
New Cumberland, PA 17070
Cumberland County 26-23-0543-203
Parcel #26-23-0543-203
H. sETTLEMENTAGENT: Affiliated Settlement Services Group, LLC
PLACE OF SETTLEMENT: 3912 Market Street, Camp Hill, PA 17011
'~ "" " "" ""'~~ 12!5!2008 PRORATION DATE: 12!5!2008 DISBURSEMENT DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
~ 40 Q
101. Contract Sales Price 108,000.00 401. Contract Sales Price
102.
Personal Property 108,000.00
402. Personal Property
103. Settlement charges to Borrower (line 1400) 6,166.73 403.
104. 404.
105. 405.
Hww I Mtrv 15 hOR ITEMS PAID BY SELLER IN ADVANCE- ~., ~„~r..~.,_.. ~,....__.._ _.._ _.. _ _.
106. City/Town Taxes
406. -- -""' "" =R in r`uvHnct
Cit /Town Taxes :
_107. County Taxes 12/05/08 to 12/31/08 30.04 407. County Taxes 12/05/08 to 12/31/08
108. Assessments
408.
Assessments 30.04
109. School Tax 12/05/08 to 06/30/09 449.48 409. School Tax 12/05/08 to 06/30/09
110. 410. 449.48
111. Trash 12/05/08 to 12/31/08 12.14 411. Trash 12/05/08 to 12131/08
112. 12.14
412.
113. 413.
114.
414.
115. 415.
120. GROSS AMOUNT DUE FROM BORROWER: 114,658.39 420. GROSS AMOUNT DUE TO SELLER:
~.. Q : ~ ~ 108,491.66
201.
Deposit or earnest money
1,000.00
501. .
Excess deposit (see instructions)
202. Principal amount of new loan(s) 106,593.00 502. Settlement charges to Seller (line 1400) 15
925
203.
Existing loan(s) taken subject to ,
.00
204. 503. Existing loan(s) taken sub'ect to
205. 504. Payoff of first mortgage loan
505. Payoff of second mortgage loan
206.
207. 5~'
208. 507. ,
209. 508.
509.
AD JDSTMFNTC Ff1R IT=~AC I Ir.lonin ov cr, , r.,. -_
-
ity/TOwn Taxes
510 --- u o T JCLLt K:
Cit /Town Taxes
211. County Taxes .
511. Coun Taxes
212. Assessments
512. Assessments
213. Sewer 10/01/08 to 12/05/08
71.84 513. Sewer 10/01/OB t
214. o 12/05/06
71.84
514.
215.
515.
216.
516.
217.
517.
218.
518.
219'
519.
220. TOTAL PAID BY/FOR BORROWER:
107,664.84 520. TOTAL REDUCTIONS IN AMOUNT DUE SELLER
....: :
15,996.84
., 600iSC A9,~{
.
301. Gross amount due from Borrower (line 120) 114
658
39 ,
601
302.
Less amount paid by/for Borrower (line 220) ,
.
0 Gross amount due to Seller (line 4201
1
0
1
7,664.84 602. Less reduction in amount due Seller (line 5201
303. CASH (®FROM) ( ~ TO) BORROWER:
6,993.55
603.
CASH (^ FROM) (® TO) SELLER: 1
5,996.84
92,494.82
D~~TCLTAC! ~jB Q I =• R w FlLE
i
i„ ~~' NUMBER: _
`
BASED ONPRICE$ 108,000.OU L 7.000/= $7,560.00
DNISION OF COMMISSION (LINE 700) AS FOLLOWS: PAID FROM
BORROWERS FUNDS PAID FROM
SELLER'S
701. S 7,560.00 to John Glise, Inc. Realtor ATSETTLEMENT FUNDS AT
702.3 to John Glise, Inc. Realtor SETTLEMENT
703. Commission paid at settlement
704. Transaction Fee to John Glise Inc. Realtor
mil $ - _ k ~i~i4T _
801. Loan Origination Fee .7500% to Wachovia Mtg FSB ($532.97 POOL)
125.00
252.73 7,560.00
125.00
802. Loan Discount Fee
803. Appraisal Fee to Michael Connor 350.00
804. Credit Report to LandAmedca 15.00
805. Lenders Inspection Fee
806. Mortgage Insurance Application Fee.
607. Assumption Fee
808. Flood Certrfication Fee to Wachovia Settlement Services, LLC 15.00
809. Application Fee to Wachovia Mortgage, FSB 60.00
810.
811.
-- ~.
9uoxl I~E~ .' _ l1 A xy~+ 'ter
901. Interest From 12/05!08 to 01/01/09 ~ $17.5200/day % (27 days)
73.04
902. Mortgage Insurance Premium for 0 Month(s) to HUD 1,833.30
903. Hazard Insurance Premium for 1 Years(s) to State Farm ($320 POCB) (320.00)
904.
905.
t 10q _ ES vt-~: E P ~;
1001. Hazard Insurance 3 months (~ $ 26.67 per month
1002. Mortgage Insurance months ~ $ 47.74 per month 80.01
1003. City Property Taxes months ~ $ per month
1004. County Property Taxes 11 months (dJ $ 35.15 per month
1005. Annual Assessments months ~ $ per month 386.65
1006. School Taxes 7 months ~ $ 66.05 per month
1007. months ~ $ per month 462.35
1008 Aggregate Acct. Adj. months (dJ $ per month
1101. Settlement or closing fee -353.98
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document preparation to Schrock & Linsenbach
1106. Notary fees to SettlemenUCterical/Notary Fees
1107. Attorney's Fees
35.00 150.00
10.00
(includes above items numbers: )
1108. Title Insurance to Affiliated Settlement Services Group,LLP 988
63
(includes above items numbers: ) .
1109. Lenders covers e $ 106,593.00
1110. Owner's coverage $ 108,000.00
1111. Ends. 100, 300, 8.1 to Affiliated Settlement Services Group,LLP
1112. Insured Closing Letter to Old Republic National Title Ins. Co.
1113. Ovemioht Fees to Affiliated Settleme
t S
i 150.00
35.00
n
erv
ces Grouo,LLP
,~ o 30.00
1201. Recording Fees: Deed $ 48.50 Mortgage $ 60.50 Release $ 109
00
_1202. CitylCounty taxlstamps Deed $ 1,080.00 Mort a e $ .
1203. State tax/stamps Deed $ 1,080.00 Mort a e $
1204.
1205.
1,080.00 1,080.00
~.. . ~ .
ti<r,iF~,_~~ ~
1301. Survey
1302. Pest Inspection
1303. Doc TransM/ire Fees to Affiliated Settlement Services G
LLP
roup,
1304. Escrow for Inheritance Tax to ASSG 40.00
1305. 7,000.00
1306.
1307.
1400. TOTAL SETTLEMENT CHARGES (Enter on line 103
Sec6on J -and
li
502
S
,
-
ne
,
ectlon Iq 6,166.73
15,925.00
I have rarefully reviewed the HUD-1 Settlement Stateme nt and m the best of my knowledge and belief, it Is a true and accurate statement of all reosipls and d Isbursemenls made on my
account or by a In this transaction. (udher certify that I have received a copy of the HUQ1 Settlement Statement.
~7 ~,
Timm . Dolin ~` ~ ~' ~^' ~t~~^
Es at Norman L. Ferris ~~'~-
The HUD-1 Settlement State nt wfiidl I have prepared is a trueand accurate account of this transaction. I have pused or will cause the funds m be disbursed In accordancewfth this
statement
Affiliated Settlem n Settlement Agent _ f ~ ~~ Q
up, LLC ` ~~ r' Date
WARNING: h is a crimeto Imowingly make take statements m the United States on this or any sinrlarfOmt. Penalties upon conviction can include a fine and Impdsonm3nt Fordetails
see: Title 18 U.S. Code Section 1001 and Section 1010.
--==
00008
ELIZABETH A FERRIS EX EST NORMAN L FERRIS
- 802 CAROL CIRCLE
NEW CUMBERLND PA 17070
I~~~III~~~III~,.i..,Ill~~~~~~llllr~ll~~lll~l~lll~~l~ll~lll~r~l
Computershare
Computershare Trust Company, N.A.
PO Box 43078
Providence, RI 02940-3078
Within the US, Canada 8 Puerto Rico BBB IBM 6700
Outside the US, Canada E Puerto Rico 781 575 2727
ibm@computershare.com
www.ibm.com~nvestor
(Go to Stockholder Services and then
Registered Stockholder Access)
HolderA,ccount Number
00008231036 F I D
iV~VhIIIIIIIIIIIfiINIIIV~IIIIII~II~V~IIIINYA
uo r csnnazoom ~ DArc'Q.cts. t ~~ i _?znhionoo~siopomsr
International Business ..Machines Corporation --Sale Advice
Class Description: DSPP -COMMON STOCK
Trade Date
Transaction Description Shares Sold Price Per Gross Amount Delduction
~ Deduction Net Amount
Share ($) of Sales ($) , Amount ($) i Type of Sale ($)
23 Jun 2008 Sale 28.649000 124.156800 3,556.97 17.90 Transaction Fee 3,539.07
Computershare Trusf Company, N.A., as agent, upon written request, will provide the name of the executing broker dealer associated with the transaction(s), and within a reasonable amount of
time will disclose the source and amount of compensation received from third parties in connection with the transaction(s), if any.
23UDC Y
I B M '}'
Opi~;Di0003 OOJISA PLEASECASHIDEPOSITTHISCHECY,PRUIdPTLY.
- ~.~ r .e'c A ~ ..~. o i,p. re•- ~ -
-_ Bank of America 64-1278
Atlanta, C)ekalb County, Georgia 61t cA
v01DAPTER 6. MOrJrHS
Pay to ELIZABETH A FERRIS EX EST NORMAN L FERRIS
802 CAROL-0IRCLE
NEW CUMBERLND PA 17070
The sum of $'~~`THREE THOUSAND FIVE HUNDRED AND THIRTY'NINE DOLLARS AND SEVEN
CENTS .~.~
Computershare, Inc.
250 Royall St, Canton, MA 02021
Check Number 0000000857
26 Jun 2008
~****3,539.07****
..Computershare, In .
Authorized Paying A nt
~--^`
~,Gw G*~
Authorized Signature(s)
11°00000008 5 7u° i:0 6 L ~ 1 2 788: 3 3 5 900 7 40 Lll^
~ ~ Prudential
~~
0001,20
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
ELIZABETH A FERRIS
802 CAROL CIRCLE
NEW CUMBERLND PA 17070
Irrtllirrrlllrtrlrtrllltrrrirllrlrrlrrtlllrrrlllrrrrrlrlll,rrl
Computershare
Computershare Trust Company, N.A.
PO Box 43033
Providence, Rhode Island 02940-3033
Within the US, I;anada 6 Puerto Rico 800 305 9404
Outside the US, Canada ~ Puerto Rica 732 512 3782
www.computershare.com/investor
Holder Account Number
00030375378 I N D
IIIIIIINIRIn~IIIIIIVIPINnVINII~~IIIIIIVI~I
001 CS(N19=.DOMCQSB]•UEBG.C1S.5379_545/000120/000120/i
Prudential Financial, Inc. --Sale Advice 12008 Tax Form 1099-B '
`Corrected (if checked) Copy B - For'Recipient Account Number oD3D375376
Form 1099-B -Proceeds from Broker and Barter Exchange Transactions 2008 Recipient's ID no, 059429a7a
.Payer's Federal ID No: 43-1912740
This is important tax information and is being furnished to the Internal Revenue Service. !f you are required to file a return, a negligence OMB No. 1545.0715
penalty or other auction maybe imposed on you'rf this income is taxable and the 1RS determines that It has not been reported. neparmient of the Tnas~ry - inlemai P.eosiue Ser.ice
' ELIZABETH A FERRIS
`Recipient 802 CAROL CIRCLE
NE'vN CUMBERLND PA 17070
to Date of Sale -- ae - z .Stocks Gross' Proceeds
or Exchange CUSIP No. Bonds, etc. ($) Reported to 1R5 Payers Details'
i 16 Jun 2008. 7443201ti2 1,551:63 Yes CCMPUTERSHARE SHAREHOLDER SERVICES INC''
P.O. BOX 43010..
° FEDERAL INCOME ' Description: Name of Issuer Transaction PROVIDENCE RI
TAX WITHHELD ($) 02940-3010..
0.00 ~ PRUDENTIACFINANCIAL INC Sale.- CD1
NOTE: Computershare will report the ameuni in Bor. 2 to the IP,S. The diffe•ence between the g~oss procaeds amount in Box 2 and the net proceeds ,
r you received represents any fees,charges,br withholding faxes you may have paid;-
Form 1099-B (Keep for your records) / ~
Summary Class Description: COMMON STOCK
Trade Transaction Description Shares/Units Price Per Gross Amount Deduction Deduction Net Amount
Date/Time Sold SharelUnit ($) of Sales ($) Amount ($) Type of Safe ($)
06/16!2008 14:01 Sale 22.000000 70.528584 1,551.63 12.76 Transaction Fee 1,538.87
Computershare Trust Company, N.A., as agent, upon written request, will provide the name of the executing broker dealer associated with the transaction(s), and within a reasonable amount of
time will disclose the source and amouni of compensation received from third parties in connection with the transaction(s), if any.
u
OO1CD70008
OOHX2E UNITS
Prudential
71 UTX
PRU
Harris Central N.A.
Roselle, Illinois
70.1558
719
~ AmeriChoice
FEDERAL CREDIT U N I O N
Building Relationships For Life
April 8, 2008
Schrack & Linsenbach Law Offices
124 Harrisburg Street
PO Box 310
Dillsburg, PA 17019
RE: Estate of Norman L Ferris
To whom it may concern:
The following is the information that you had requested in your correspondence.
The decedent had one member number (11657) with a savings (O1) and checking (13)
account. It was originally established as a joint account with his wife, after her death
Elizabeth Ferris was added on 07/13/07.
The savings account was opened on 08/02/1977.
The checking account was opened on 05/21/1984.
Date of death balance (03/01/2008) is as follows:
Savings-$535.01
Checking-$25,206.15
If you have any more questions concerning this account, please contact me at 717-697-
3474, ext. 4515.
Sincerely, ~ / ~~
Maggie Strohm ~ vj
Operations Administrator ~/
Main Office: 217.5 Bumble Bee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) 697-3474 • Fax: (717) 697-3713
`+_ _-_ _ Website: www.americhoice.org ~~~
_NCUA E,,,,~ '-r_
~oeR LENDER """ "'
CREDIT UNIONS'
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FREYSINGER PONTIAC, GMC, BUICK, MAZDA, HYUNDAI, INC.
6251 CARLISLE PIKE / MECHAINICSBURG, PA 17050 • TEL. 717-766-8422
~o w~,., az mac ,,
o,~,,,
~12~\ ~- \ C-~2t~~-5~ ~1 Q ~ ~n5~\o3~~ . C~ ~ ~ - is - o~,
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~ AmeriChoice
.~
F E D E R A L CREDIT U N I O N
Building Relationships For Life
April 8, 2008
Schrack & Linsenbach Law Offices
124 Harrisburg Street
PO Box 310
Dillsburg, PA 17019
RE: Estate of Norman L Fen-is
To whom it may concern:
The following is the information that you had requested in your correspondence.
The decedent had one member number (11657) with a savings (O1) and checking (13)
account. It was originally established as a joint account with his wife, after her death
Elizabeth Ferns was added on 07/13/07.
The savings account was opened on 08/02/1977.
The checking account was opened on 05/21/1984.
Date of death balance (03/01/2008) is as follows:
Savings-$535.01
Checking-$25,206.15
If you have any more questions concerning this account, please contact me at 717-697-
3474, ext. 4515.
Sincerely,
Maggie Strohm ~ v)
Operations Administrator ~/
Main Office: 2175 Bumble Bee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) 697-3474 • Fax: (717) 697-3713
~~ Website: www.americhoice.org
• - • ~NCUA Equsl
Opportunely
~oea LENDER
~~~
CREDIT UNIONS"
~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
September 25, 2008
SCHRACK & LINSENBACH ATTORNEYS AT LAW
BRIAN C. LINSENBACH, ESQUIRE
124 WEST HARRISBURG ST
PO BOX 310
DILLSBURG PA 17019
Re: NORMAN FERRIS
CIS #: 540185445
SSN: 096-16-9864
Date of Death: 03/01/2008
Dear Attorney Linsenbach:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $40,221.85 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department: according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A poz-tion of this medical expense, namely $24,492.54, was incurred
during the: last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $15,729.31, is
to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
Marie A. Trayer
Claims Investigation Agent
717-772-6723
717-705-8150 FAX
Enclosure
PLEASE NOTE:
Asher my telephone call please find the Department's UPDATED Statement
of Claims (lien) for the above referenced decedent's estate. The Statement of
Claim dated April 17, 2008 is Null & Void.
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